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"Fast Track" AND "Emergency"

N A Sizonenko, D A Surov, I A Solov'ev, A E Demko, A V Osipov, M A Gabrielyan, A L Pavlovsky
Effectiveness of enhanced recovery program is being earnestly confirmed in various surgical areas. Certain aspects of fast track rehabilitation are analyzed in the article.
2018: Khirurgiia
Khairunnisa Abdul Ghaffar, Lisa F P Ng, Laurent Renia
In early 2014, a relatively obscure virus, the Zika virus, made headlines worldwide following an increase in the number of congenital malformations. Since then, research on Zika virus, treatment and vaccines have progressed swiftly with various drugs being repurposed and vaccines heading into clinical trials. Nonetheless, the need for a vaccine is crucial in order to eradicate this re-emerging arthropod-borne virus which remained silent since its first discovery in 1947. In this review, we focused on how the inconspicuous virus managed to spread, the key immunological factors required for a vaccine and the various vaccine platforms that are currently being studied...
November 21, 2018: Vaccines
Adam Richardson, Semhar Z Tewelde, Zachary D W Dezman
A 48-year-old male with a history of intravenous (IV) drug use presented to the emergency department (ED) for an area of mild pain and erythema on his chest. He was then triaged to the urgent care, or fast track, area of the ED. He was well appearing with normal lab findings and vital signs, but his workup revealed mediastinitis with osteomyelitis of the manubrium and clavicles, a surgical emergency. His treatment course included IV antibiotics and operative intervention with thoracic surgery. The patient looked too good to be sick , yet he had a life-threatening infection...
November 2018: Clinical practice and cases in emergency medicine
Himanshu L Kataria, Marc A Jacobson
Introduction: Elderly patients often present to the emergency department (ED) with nonspecific signs of infection and excessive fluid loss, with limited research into their management. The purpose of this audit was to assess the initial management of hypotensive elderly patients in the ED: observations within 15 min, fluid challenge within 1 h, time to assessment by a physician, and initial management of septic shock. Subjects and Methods: Online patient systems were reviewed to find 40 patients >65 years old who were hypotensive (systolic blood pressure <100 mmHg or diastolic blood pressure <60 mmHg) in the ED between 1st October 2015 and 16th November 2015...
July 2018: Journal of Emergencies, Trauma, and Shock
Auwal I Kabuga, Mohamed E El Zowalaty
Since the eradication of smallpox approximately 39 years ago, monkeypox virus remains the most pathogenic poxvirus, being mainly restricted to Central and West Africa. Before 1970, there were no reports of human monkeypox in Nigeria, while between 1971 and 1978 there were three cases, with none having been reported thereafter. However, in September 2017, a case of contagious skin rash disease, typical of monkeypox, was observed in an 11-year-old boy from the southern part of the country, and confirmed to be associated with the monkeypox virus...
October 24, 2018: Journal of Medical Virology
Alberto Carli, Francesca Moretti, Giulia Giovanazzi, Valentina Niero, Valeria Perilli, Giovanna Ghirlanda, Chiara Bovo, Stefano Tardivo
BACKGROUND AND AIM: Patients could leave ED not receiving the desired care either Without Being Seen by a doctor (LWBS) or Against Medical Advice (DAMA). In term of care quality, LWBS may be related to inappropriate access and process of care, while DAMA may lead to increased risk of mortality and re-admissions. This study aims to identify frequency of patients who leave ED, determine their characteristics and identify associated factor. METHODS: This was a retrospective observational study of patients that attended EDs of University Hospital Trust of Verona in 2017...
October 8, 2018: Acta Bio-medica: Atenei Parmensis
Kirsten Specht, Hanne Agerskov, Per Kjaersgaard-Andersen, Rebecca Jester, Birthe D Pedersen
BACKGROUND: Due to the shortened length of stay in fast-track total hip and knee arthroplasty, patients must at a very early stage following surgery take responsibility for their postoperative care and treatment. It is important to establish if this treatment modality of fast-track is not only cost-effective, but meets patients' expectations and needs. AIM: To explore the lived experience of patients in fast-track total hip and knee arthroplasty during the first 12 weeks after discharge...
November 2018: International Journal of Orthopaedic and Trauma Nursing
Fabrice Petitjeans, Cyrille Pichot, Marco Ghignone, Luc Quintin
Acute respiratory distress syndrome (ARDS) is not a failure of the neurological command of the ventilatory muscles or of the ventilatory muscles; it is an oxygenation defect. As positive pressure ventilation impedes the cardiac function, paralysis under general anaesthesia and controlled mandatory ventilation should be restricted to the interval needed to control the acute cardio-ventilatory distress observed upon admission into the critical care unit (CCU; "salvage therapy" during "shock state")...
September 2018: Turkish Journal of Anaesthesiology and Reanimation
Alberto Tlacuilo-Parra, Sandy P López-Valenzuela, Gabriela Ambriz-González, Elizabeth Guevara-Gutiérrez
Objetivo: Comparar la seguridad y la eficacia de la atención fast-track vs. atención convencional en apendicitis no complicada en un hospital pediátrico. Método: Ensayo clínico controlado, aleatorizado, con dos grupos de 30 pacientes cada uno: A) fast-track, apendicitis no complicada que cumplieron el programa; y B) atención convencional, apendicitis no complicada con atención habitual. Variables de seguridad y eficacia: proporción de complicaciones y tiempo de estancia hospitalaria...
2018: Cirugia y Cirujanos
Charles Hobson, Nicholas Lysak, Matthew Huber, Salvatore Scali, Azra Bihorac
OBJECTIVE: Conventional clinical wisdom has often been nihilistic regarding the prevention and management of acute kidney injury (AKI), despite its being a frequent and morbid complication associated with both increased mortality and cost. Recent developments have shown that AKI is not inevitable and that changes in management of patients can reduce both the incidence and morbidity of perioperative AKI. The purpose of this narrative review was to review the epidemiology and outcomes of AKI in patients undergoing vascular surgery using current consensus definitions, to discuss some of the novel emerging risk stratification and prevention techniques relevant to the vascular surgery patient, and to describe a standardized perioperative pathway for the prevention of AKI after vascular surgery...
September 2018: Journal of Vascular Surgery
Glenn Larsson, Ulf Strömberg, Cecilia Rogmark, Anna Nilsdotter
Background: Older patients with a hip fracture require specialized emergency care and their first healthcare encounter before arriving at the hospital is often with the ambulance service. Since 2005 there has been a registered nurse on the crew of every ambulance in Sweden in order to provide prehospital emergency care and to prepare the patients for hospitalization. It is important to investigate patient satisfaction with prehospital emergency care following a hip fracture to ensure that their expectations of good care are met...
2018: BMC Nursing
Loren De Freitas, Steve Goodacre, Rachel O'Hara, Praveen Thokala, Seetharaman Hariharan
OBJECTIVES: Patient flow and crowding are two major issues in ED service improvement. A substantial amount of literature exists on the interventions to improve patient flow and crowding, making it difficult for policymakers, managers and clinicians to be familiar with all the available literature and identify which interventions are supported by the evidence. This umbrella review provides a comprehensive analysis of the evidence from existing quantitative systematic reviews on the interventions that improve patient flow in EDs...
October 2018: Emergency Medicine Journal: EMJ
Jeong-Ju Yoo, Won Kim, Moon Young Kim, Dae Won Jun, Sang Gyune Kim, Jong-Eun Yeon, Jin Woo Lee, Yong Kyun Cho, Sang Hoon Park, Joo Hyun Sohn
Nonalcoholic fatty liver disease (NAFLD), together with metabolic syndrome and obesity, has shown a rapid increase in prevalence worldwide and is emerging as a major cause of chronic liver disease and liver transplantation. Among the various phenotypes of NAFLD, nonalcoholic steatohepatitis (NASH) is highly likely to progress to development of end-stage liver disease and cardiometabolic disease, resulting in liver-related and non-liver-related mortality. Nonetheless, there is no standardized pharmacotherapy against NASH and many drugs are under development in ongoing clinical trials...
August 8, 2018: Clinical and Molecular Hepatology
R Sudhakaran, Jeetinder K Makkar, Divya Jain, Jyotsna Wig, R Chabra
Background and Aims: Several techniques have evolved over time to monitor depth of anesthesia and ensure enhanced recovery. This randomized double-blinded trial was designed to compare bispectral index (BIS) or end-tidal anaesthetic concentration (ETAC) monitoring on the recovery characteristics of patients undergoing thoracolumbar spine surgeries. Methods: Seventy American Society of Anesthesiologist I-II patients of either sex were randomized to Group B - BIS-guided protocol, Group E - ETAC-guided protocol, or Group S - Standard protocol...
July 2018: Indian Journal of Anaesthesia
Carol Anne Celona, Andrew Amaranto, Robin Ferrer, Matt Wieland, Stacy Abrams, Farley Obusan, Sharon LoPuzzo, Valsamma Joy
Delays in medical care will increase risks for patients. For this reason, timeliness of care is a public health priority and the one of the missions for this facility. The goal of this process improvement project was to enhance timeliness of care by restructuring fast track. Door-to-provider time, treat and release time, and the number of patients who left without being seen by a provider were monitored. Nurse practitioners were introduced into advanced practice provider mix and the development of care teams was implemented...
July 2018: Advanced Emergency Nursing Journal
Morten Langfeldt Friberg, Leif Rognås
OBJECTIVES: The primary objective was to estimate the incidence of patients in the Central Denmark Region triaged to bypass the local emergency department without being part of a predefined fast-track protocol. The secondary objective was to describe these triage decisions in more detail with regard to the most common diagnoses, incidence of direct referral sorted by the prehospital critical care team (PHCCT) and the destination hospital. DESIGN: Retrospective descriptive study...
July 18, 2018: BMJ Open
Silvia Ratto-Kim, In-Kyu Yoon, Robert M Paris, Jean-Louis Excler, Jerome H Kim, Robert J O'Connell
The US military has been a leading proponent of vaccine development since its founding. General George Washington ordered the entire American army to be variolated against smallpox after recognizing the serious threat that it posed to military operations. He did this on the recommendation from Dr. John Morgan, the physician-in-chief of the American army, who wrote a treatise on variolation in 1776. Although cases of smallpox still occurred, they were far fewer than expected, and it is believed that the vaccination program contributed to victory in the War of Independence...
2018: Frontiers in Immunology
A I Khripun, I V Sazhin, S N Shurygin, G B Makhuova
AIM: To analyze the outcomes of fast track rehabilitation program in patients with perforated duodenal ulcer (PDU). MATERIAL AND METHODS: For the period 2013-2016 at the Department of Surgery and Endoscopy 206 PDU patients have been treated. Inclusion criterion for the main group (n=77) was duodenal ulcers, their dimension up to 1 cm, laparoscopic suture of perforated ulcer, fast track rehabilitation program implementation. The control group consisted of 129 patients who underwent open suturing of perforated ulcer followed by conventional treatment in postoperative period...
2018: Khirurgiia
Bodil Ivarsson, Ami Hommel, Magnus Sandberg, Desirée Sjöstrand, Anders Johansson
BACKGROUND: Hip fractures are described to have a significant impact on patients' well-being and different fast-track concepts could result in a reduction of the patient's psychological and emotional reactions before pre- and intrahospital care. AIMS AND OBJECTIVES: This study aimed to elucidate perceived situations of significance experienced by patients with hip fracture during the prehospital- and in-hospital care. DESIGN: The study used a qualitative approach using a critical incident technique (CIT), 14 patients with hip fractures were included...
August 2018: International Journal of Orthopaedic and Trauma Nursing
Camilla Strøm, Lars Simon Rasmussen, Anne-Sophie Löwe, Anne Kathrine Lorentzen, Nicolai Lohse, Kim Hvid Benn Madsen, Søren Wistisen Rasmussen, Thomas Andersen Schmidt
Background: the effect of hospitalisation in emergency department-based short-stay units (SSUs) has not been studied in older patients. We compared SSU hospitalisation with standard care at an Internal Medicine Department (IMD) in acutely admitted older internal medicine patients. Methods: pragmatic randomised clinical trial. We randomly assigned patients aged 75 years or older, acutely admitted for an internal medicine disease and assessed to be suitable for SSU hospitalisation to SSU hospitalisation or IMD hospitalisation...
November 1, 2018: Age and Ageing
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